The overall objective of this proposal is to obtain definitive evidence for the effectiveness of a short preoperative Pulmonary Rehabilitation on the morbidity and recovery from a curative surgical resection in patients with Lung Cancer and severe Chronic Obstructive Pulmonary Disease (COPD). The long term goal of this research agenda is to innovate the preoperative care of lung cancer resection in patients with low lung function, and ultimately translate these improvements to all thoracic surgical procedures (such as esophageal cancer, coronary artery bypass surgery, etc.) and to impact on quality of life and physical activity trajectory, proposed mediators of lung cancer survival. The rationale for the need of this research is the lack any well proven risk-reducing intervention that may decrease the morbidity of lung cancer resection in patients with severe COPD or that may improve their quality of life or physical activity trajectory, meaningful variables in the overall disease progression. The proposed intervention is unique as it combines exercise and behavioral interventions that were pilot tested in a randomized single-blinded controlled design in the proposed population and proved feasible and potentially effective. This application brings together solid preliminary data with centers of excellence in Pulmonary Rehabilitation and thoracic surgery to conduct a study that will advance the field of preoperative and chronic care. We will describe the process of rehabilitation and recovery in-depth, test our hypotheses, and achieve the objective of this application by pursuing the following specific aims: Specific Aim 1: To prospectively determine the effect of 10 sessions of customized preoperative Pulmonary Rehabilitation on length of hospital stay and on the number of postoperative complications in patients that undergo a lung cancer resection and have severe COPD compared to a matched control group. Hypothesis: Ten sessions of customized preoperative Pulmonary Rehabilitation will significantly reduce the length of hospital stay and the number of postoperative pulmonary complications. Specific Aim 2: To prospectively determine the effect of a 10-session preoperative Pulmonary Rehabilitation on the trajectory of quality of life and measured physical activity at 3, 6 and 12 month after the curative resection compared to a matched control group. Hypothesis: Ten sessions of customized preoperative Pulmonary Rehabilitation will significantly and meaningfully (more than the minimal clinically important difference) improve physical activity and quality of life after surgery compared to a control group. PUBLIC HEALTH RELEVANCE: The overall objective of this proposal is to obtain definitive evidence for the effectiveness of a short preoperative Pulmonary Rehabilitation on the morbidity and recovery from a curative surgical resection in patients with Lung Cancer and severe Chronic Obstructive Pulmonary Disease (COPD).